Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal Immediate Past National President IMA The IMA has been opposing the proposed NMC Bill in its present format on several grounds. Following a country-wide 12-hour strike on 2nd January this year, the proposed NMC Bill was referred to a Parliamentary Standing Committee. The Rajya Sabha Committee considered each clause of the proposed NMC Bill and has given its recommendations on each in Chapter 4 of its report “109th Report on the National Medical Commission Bill, 2017 (Presented to the Rajya Sabha on 20th March, 2018) (Laid on the Table of Lok Sabha on 20th March, 2018)”. The report is in the public domain. To deliberate on the report, the IMA is organizing a Mahapanchayat on 25th March at Indira Gandhi Stadium, New Delhi, 10 am to 2pm. Over 10,000 doctors from all across the country will deliberate on the issue. As per a note from our National President Dr Ravi Wankhedkar, “after the 1st victory due to the Surgical Strike of 2nd Jan, IMA’s massive pressure has achieved the 2nd victory. Some of IMA demands have been accepted in the Parliamentary Standing Committee report. But the committee report is just a recommendation. Government has to accept and implement these recommendations along with remaining demands.” 25th March is an opportunity to show our strength to the whole world. Collectively, we see and influence over two crore patients every month. Collectively, on the 25th we should also show that we can also influence government policies and turn them into community-friendly policies. Most government policies today have penal provisions for doctors likening us to criminals. There are no policies to protect us. The govt. has failed to formulate and implement even a simple demand for a stringent central act for violence against doctors. Doctors are not supposed to be on the roads protesting. True. Therefore, we are continuing our efforts towards our legitimate demands, the Gandhian way. The Mahapanchayat is a corollary of the Dilli Chalo movement on the 6th June last year followed by a dawn-to-dusk fast observed throughout the country on 2nd October, the birth anniversary of Mahatma Gandhi. Each movement must be bigger than the previous. The critical mass of one percent must be achieved for any movement to spontaneously spread across the entire nation. All those who joined physically the Dilli Chalo movement on 6th June last year must repeat their presence, but this time with one more additional friend. You can bring a Non- IMA member or even a non-medical friend to participate. Delhi Medical Association is hosting the Mahapanchayat. Hence, all doctors from Delhi, in particular, should achieve this critical mass. It’s time… we should seize this opportunity. We must persist in our efforts till our goals are achieved. Cancel all your appointments on 25th March. Just join the mass movement.

There has always been a dispute whether healthcare is a commercial business or a social business. The first step in regulation of the medical profession was taken when the medical profession was brought under the Consumer Protection Act (CPA). Consequently, any medical service provided to the patient in the form of consultation, diagnosis and treatment came to be under the ambit of ‘service’ as defined in the CPA.

In several of its judgements, the Hon’ble Supreme Court of India has stated that costs/charges in the medical profession must be reasonable. In the matter of Samira Kohli vs Dr. Prabha Manchanda & Anr on 16 January, 2008, the Apex Court said, “28. But unfortunately not all doctors in government hospitals are paragons of service, nor fortunately, all private hospitals/doctors are commercial minded. There are many a doctor in government hospitals who do not care about patients and unscrupulously insist upon unofficial payment for free treatment or insist upon private consultations. On the other hand, many private hospitals and Doctors give the best of treatment without exploitation, at a reasonable cost, charging a fee, which is reasonable recompense for the service rendered. Of course, some doctors, both in private practice or in government service, look at patients not as persons who should be relieved from pain and suffering by prompt and proper treatment at an affordable cost, but as potential income-providers/ customers who can be exploited by prolonged or radical diagnostic and treatment procedures. It is this minority who bring a bad name to the entire profession.”

The word to be taken note of here is “exploitation”. You cannot charge more in an emergency. If you do, this may mean that you are exploiting the patient.

Earning a profit is required for sustenance. But should this justify profiteering? A very fine line separates the two, which must never be crossed.

The word “reasonable” needs to be defined. The govt. always wanted to cap pricing in the medical profession. Towards this end, the govt. introduced the Clinical Establishments Act (CEA) to regulate prices in health care, which was opposed by the IMA.

The govt. is now trying to control prices via TPA, CGHS, state government health scheme and now through the newly launched “National Health Protection Scheme” under the Ayushman Bharat initiative announced in the Budget on Feb.1, 2018. The National Health Protection Scheme will provide coverage of Rs 5 lakh rupees per family per year for secondary and tertiary hospitalization, but only under the ‘general ward’ category to about 50 crore beneficiaries. This scheme may be taken advantage of or exploited.

This means that the govt. may cap the prices for each procedure as it did under the Rashtriya Swasthya Bima Yojana (RSBY), a health insurance scheme for the Below Poverty line (BPL) families, which provided a coverage of Rs 30, 000/- per annum to beneficiaries on a family floater basis. Under this scheme, the govt. has framed indicative package rates for several interventions or procedures.

The only way health sector can be controlled is by way of re-imbursement. Just as the HMOs have controlled healthcare costs in the US, insurance companies in India too may control pricing in India.

Two types of costs may be worked out; one, a reasonable’ cost, one which could be covered under the ‘general ward’ category as directed by the govt. and the other a ‘private’ cost, which is not capped and allows charging as per the paying capacity of the patient.

If we don’t self-regulate, then the govt. will. Then we may have no choice but to comply with the price cap that has been put by the govt.

New Delhi, 27 December 2017: The Union Cabinet recently rendered another blow to the medical profession with the approval of the draft National Medical Commission Bill, 2017. The NMC will “cripple” the functioning of the medical profession by making it completely answerable to the bureaucracy and non-medical administrators. Devoid of federal character, this non-representative half non-medical body will be a poor substitute for the MCI. NMC will not represent the medical profession of India in any manner.

Delivering affordable health care to India’s billion plus people presents enormous challenges and opportunities for the medical fraternity. Political ideologies play a distinctive role in determining the health policies of our country. The profession is fighting to ensure that further escalation of healthcare costs can be avoided. This, again, is only for the greater good of the community. This and other points were discussed at the Annual Central Council Meeting of the IMA held in Mumbai.

“Medical profession is regarded as a noble profession and no other profession has been given a similar high status. ‘Doctors treat, but God heals’ is a well-known saying. Doctors are considered next to Gods and hence require no regulators. They need to self-regulate themselves,” said Dr KK Aggarwal National President IMA during the Annual Central Council meeting.

Addressing the Central Council meeting, Dr KK Aggarwal and Dr Ravi Wankhedkar Incoming National President IMA, in a joint statement, said, “Dharma of a doctor is to treat and save the life of a person at any cost. It is time that the community supports us as we support them. We speak the loudest when we speak with one voice. Now, all corporate houses shall have to follow the MCI ethics and will help the profession provide affordable healthcare.”

Honorary Secretary General IMA Dr R N Tandon said, “Today, IMA is the largest medical professional body and is committed to affordable health care.”

The IMA has added the following in the last one year.

New medical emblem for doctors to differentiate MBBS doctors from non-MBBS doctors

IMA self-regulation code

A one-day educational event on TB with over 1000 doctors in March 2018

IMA policy on preventing antibiotic resistance

IMA restoration guidelines

IMA declaration of pollution as public health emergency\

IMA policy on writing NLEM drugs and capping the prices of non-NLEM items

New guidelines on criminal prosecution of doctors

IMA no incentive policy (no cuts, no commissions, no referral fee without service)

IMA accreditation of clinics, less than 50 bedded medical establishments and educational programmes